09 Respiratory and Allergy Medications

Respiratory treatment principles

Respiratory medicines are commonly distinguished by their generic name, brand example, drug class, and indication. Brand names help with recognition, but product formulations and names can vary; check the active ingredients on combination-product labels.

Asthma features variable airway narrowing and inflammation. COPD causes persistent airflow limitation, and its long-term treatment commonly emphasizes bronchodilation. Some medicines are used for both conditions, but their roles differ.

Asthma and COPD medicines

Asthma treatment

Inhaled corticosteroids (ICS) are foundational anti-inflammatory controllers for asthma. Budesonide (Pulmicort Flexhaler) and fluticasone (Arnuity Ellipta) are examples. They help prevent symptoms and exacerbations but are not rapid rescue medicines. Rinse the mouth after use to reduce the risk of oral thrush.

Albuterol (Ventolin HFA), a short-acting beta₂ agonist (SABA), rapidly relieves bronchospasm and is a common rescue inhaler for asthma and COPD. Formoterol and salmeterol (Serevent) are long-acting beta₂ agonists (LABAs) used as maintenance bronchodilators. In asthma, a LABA should not be used without an ICS.

Formoterol has a rapid onset. When prescribed in an appropriate ICS–formoterol regimen, it can serve as both maintenance and reliever therapy. Budesonide/formoterol (Symbicort) and fluticasone/salmeterol (Advair) are ICS/LABA combinations used as asthma controllers; they are also used in selected COPD regimens. Only an ICS/formoterol combination may be used as a reliever in an appropriate asthma plan—not every ICS/LABA inhaler.

Montelukast (Singulair) is an oral leukotriene-receptor antagonist and a controller option for asthma and allergic rhinitis, not a rescue medicine. It carries an FDA boxed warning about serious neuropsychiatric effects.

COPD treatment

Long-acting bronchodilators, often a LABA/LAMA combination, are central maintenance treatments for COPD. Tiotropium (Spiriva) and umeclidinium (Incruse Ellipta) are long-acting muscarinic antagonists (LAMAs); they are long-acting maintenance bronchodilators, especially common in COPD. Tiotropium may also be added for some patients with asthma.

Umeclidinium/vilanterol (Anoro Ellipta), a LAMA/LABA combination, provides maintenance bronchodilation for COPD and is not a rescue inhaler. Fluticasone/umeclidinium/vilanterol (Trelegy Ellipta) is ICS/LAMA/LABA triple therapy for selected patients with COPD. An ICS-containing regimen is important when COPD coexists with asthma.

An ICS may be added for selected people with COPD, including those with asthma features or ongoing exacerbations; it is not a routine substitute for bronchodilation. Prednisone, a systemic corticosteroid, may be prescribed in short courses for significant asthma or COPD exacerbations. Long-term use has substantial adverse effects.

Allergy medicines

Cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) are second-generation H₁ antihistamines used for sneezing, itching, and runny nose from allergic rhinitis. They are generally less sedating than older antihistamines, although drowsiness can still occur.

Diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) are first-generation H₁ antihistamines. They can cause sedation and anticholinergic effects such as dry mouth, so use caution with activities requiring alertness.

Fluticasone (Flonase) and mometasone (Nasonex) are intranasal corticosteroids for persistent nasal allergy symptoms. They are effective when used regularly and with correct spray technique, and are among the most effective treatments for allergic rhinitis. Azelastine (Astelin), an intranasal antihistamine, may cause a bitter taste or drowsiness.

Decongestants target stuffiness. Oral pseudoephedrine (Sudafed) may raise blood pressure or heart rate and can cause insomnia. Topical nasal oxymetazoline (Afrin) provides short-term relief; avoid prolonged use because rebound congestion can occur.

Epinephrine (EpiPen), an alpha- and beta-adrenergic agonist, is the emergency first-line medicine for anaphylaxis. Antihistamines do not replace it.

Cough, cold, and symptom relief

Dextromethorphan (Delsym) is an antitussive that temporarily suppresses cough; it treats the symptom, not the cause. Guaifenesin (Mucinex) is an expectorant that helps loosen mucus and make a productive cough easier to clear. Benzonatate (Tessalon) is a prescription peripheral antitussive; its capsules must be swallowed whole.

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) may relieve fever, headache, aches, or sore throat associated with a cold. Acetaminophen is an analgesic and antipyretic; ibuprofen is an NSAID. Neither treats the virus itself.

A cold is usually viral, so symptom-relief medicines do not cure it or shorten its course. Antibiotics are not routine cold medicines; they are used only when a bacterial infection is suspected or diagnosed.

Medicine safety and urgent symptoms

Common cold products may combine a cough suppressant, expectorant, decongestant, antihistamine, and/or pain reliever. Check each active ingredient to avoid accidentally doubling medicines such as acetaminophen. Oral phenylephrine appears in some products, but the FDA has questioned its effectiveness as an oral nasal decongestant.

Decongestants may be unsuitable for some people with high blood pressure or other conditions. Follow product warnings and ask a pharmacist or clinician when uncertain. More generally, remember the distinctions: albuterol provides quick bronchodilation, while an ICS controls asthma inflammation; LAMA/LABA combinations are common COPD maintenance therapy, while rescue inhalers act faster. For nasal allergies, intranasal steroids address persistent symptoms, antihistamines mainly relieve histamine-related symptoms such as itching and sneezing, and decongestants target stuffiness.

Persistent or severe breathing difficulty, chest pain, blue lips, or a rapidly worsening asthma/COPD flare needs prompt medical assessment.

• Long-acting beta₂ agonist (LABA)

• Inhaled corticosteroid (ICS)